| NPI | 1285001842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MI T615802497876) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: MI 3019283855) |
| 133N00000X Nutritionist (Licence: CA 1849503021) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA TT37598187) | |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: CA TT37598187) | |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: MI T615802497876) | |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2022-08-13 |